Health & Safety Policy & Assignment of

Responsibility Samples
Table of Contents Page
Company Health and Safety Policy - Sample 1 2
Company Health and Safety Policy - Sample 2 4
Company Health and Safety Policy - Sample 3 5
Company Assignment of Responsibilities - Sample 1 6
Company Assignment of Responsibilities - Sample 2 10
Company Assignment of Responsibilities - Sample 3 12

The samples provided in this section must be customized to your company. They should include
specific frequencies, responsibilities and your company’s name where appropriate. Only one of
each policy/form should be selected and implemented for each section.
 Sample Company Health and Safety Policy

Scope
This policy will apply to Company Name / Organization and all of its locations.

Policy
Company Name / Organization is committed to providing a safe and healthful work
environment for its employees and is dedicated to the objective of eliminating the possibility of
injury and illness. To express that commitment, we issue the following policy.

As (President, Owner, Operator, CEO, Etc.), I give you my personal promise to take all
reasonable precautions to prevent harm to workers.

Company Name / Organization through all levels of management, will co-operate with the Joint
Occupational Health and Safety Committee (JOHS), or the representative and employees to
create a safe and healthful work environment. The same co-operation will be extended to
others such as contractors, owners, officers, etc.

Managers and supervisors will be trained and held responsible for ensuring that the employees,
under their supervision, follow this policy, use safe work practices and receive training to
protect their health and safety. Managers and supervisors also have a general responsibility for
ensuring the safety of equipment and facility.

The employees of Company Name / Organization will be required to support this organizations
health and safety initiative and to co-operate with the Occupational Health and Safety
Committee representative and with others exercising authority under the applicable laws.
Management commits to working in a spirit of consultation and co-operation with the
employees in achieving the company’s health and safety initiatives.

It is the responsibility of all personnel employed by this company to report to their supervisor,
manager, safety representative or member of the JOHS committee as soon as possible, any
hazardous conditions, injury, accident, or illness related to the workplace. Also, employees
must protect their health and safety by complying with applicable Acts and Regulations and to
follow policies, procedures, rules and instructions as prescribed by Company Name /
Organization.

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Company Name / Organization will, where possible, eliminate hazards and, thus, the need for
personal protective equipment. If that is not possible, and where there is a requirement,
employees will be required to use safety equipment, clothing, devices and materials for
personal protection.

Company Name / Organization recognizes the employees’ duty to identify hazards and supports
and encourages employees to play an active role in identifying hazards and to offer suggestions
or ideas to improve the health and safety program.

Signed: Date:

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 Sample Company Health & Safety Policy

This company is committed to a strong safety program that protects its staff, its property and
the public from incident.

Employees at every level, including management, are responsible and accountable for the
company’s overall safety initiatives. Complete and active participation by everyone, everyday,
in every job is necessary for the safety excellence the company expects. Management supports
co-ordination of safety among all workers on the job site and commits to working in a spirit of
consultation and co-operation with it’s workers in achieving a safe and healthful work
environment.

Management supports participation in the program by all employees and provides proper
equipment, training and procedures. Employees are responsible for following all procedures,
working safely, and wherever possible, improving safety measures.

An injury and incident free workplace is our goal. Through continuous safety and loss control
efforts, we can accomplish this.

* The safety information in this policy does not take precedence over the Occupational Health
and Safety Act. All employees should be familiar with the Occupational Health and Safety Act.

Signed: Date:

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 Company Health & Safety Policy

Company Name / Organization is committed to the prevention of incidental loss concerning its
resources, including employees and physical assets.

In fulfilling this commitment to protect both people and property, management will provide
and maintain a safe and healthful work environment in accordance with industry standards and
in compliance with legislative requirements. Company Name / Organization will strive to
eliminate any foreseeable hazards which may result in property damage, incidents or personal
illness.

All employees will be equally responsible for minimizing incidents within our facilities. Safe
work practices and safe job procedures will be clearly defined in the safety manual for all
employees to follow.

Incident loss can be controlled through good management in combination with active
employee involvement. Safety is the direct responsibility of all managers, supervisors, and
employees. Management commits to working in a spirit of consultation and co-operation with
its employees in maintaining a safe and healthful work environment.

All management functions will comply with company safety requirements as they relate to
planning, operation and maintenance of facilities and equipment. All employees will perform
their jobs properly in accordance with established safe job procedures and safe work practices.

I trust that all of you will join me in a personal commitment to make safety a way of life.

* The safety information in this policy does not take precedence over the Occupational Health
and Safety Act. All employees should be familiar with the Occupational Health and Safety Act.

Signed: Date:

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 SAMPLE ASSIGNMENT OF RESPONSIBILITIES

Managers

• Provide a statement of policy relating to the safety program. The statement provides a
commitment and philosophy that set levels of expectations for safety performance
throughout the corporation.

• Maintain overall control of the Safety and Loss Prevention Program direction.

• Ensure all established safety policies are administered and enforced in all areas.

• Ensure that all field operations personnel are aware of and effectively practice the
policies and procedures set out in the safety program.

Superintendents

• Ensure implementation and maintenance of the established safety policies on specific

projects within their respective areas of jurisdiction.

• Ensure the maintenance of the highest standards of performance with respect to the
safety program on their respective job-sites. They are also accountable for the safe
performance of personnel and equipment on their projects.

• Implement a site safety program and develop a clear understanding of safety

responsibilities and specific duties for each foreman or supervisor. The Superintendent
must be knowledgeable of and responsible for complying with all regulations, laws and
codes.

• Hold at least one safety meeting bi-weekly with foremen to review safety conditions and
general safety policies. Ensure that sub-trades and foremen conduct weekly toolbox
meetings. Where there are only a few employees, the Superintendent shall conduct a
weekly toolbox meeting with all project personnel in attendance.

• Arrange for the recording of minutes of safety committee meetings and forward copies
to the Manager.

• Make daily observations of safety activities on the project.

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 • Accompany Department of Labour Inspector(s) during project inspection. If he/she is
not available, the Superintendent will assign another supervisor for the inspection.

• Be aware of the hazards that exist for the short term, temporary and the newly hired
worker who is new to construction activities. Ensure that new hires receive detailed
safety instructions before they are allowed to start work. New employees should be
assigned to work with other employees who are familiar with the project and are aware
of any specific safety rules and regulations that are in force.

• Formulate a detailed hiring routine for all employees which includes a review of the project
safety rules and regulations prior to starting work (New Hire Orientation).

Supervisors/Foremen

• Provide safe working conditions for all workers under his/her supervision.

• Provide instructions to workers in safe work procedures. As part of the routine duties, the
Supervisor shall require employees to use personal protective equipment as appropriate,
eg. hard hats, goggles, masks, respirators, safety glasses or other items deemed necessary.

• Correct physical conditions which are liable to cause of have caused incidents.

• Undertake the investigation of incidents, or near misses to determine the underlying

causes. These must be reported in detail to the Superintendent and the required report
forms completed on a timely basis.

• Provide a good example for employees by always directing and performing work in a safe
manner.

• Conduct regular inspections for unsafe practices and conditions and ensure prompt
corrective action to eliminate causes of incidents.

• Work in co-operation with other project supervisory personnel in determining safe

practices, enforcing their observance, developing procedures for dealing with violations and
developing other general safety and incident prevention procedures.

• Provide each employee with information about hazards on the job and how to avoid them.

• Maintain a house keeping standard and assign definite responsibilities to individuals for
good housekeeping.
• Enforce all established safety regulations and work methods. Take disciplinary action as
necessary to ensure compliance with the rules.
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• Provide a minimum of one toolbox meeting a week with his/her crew and record minutes
on the prescribed form.

• Provide a regular inspection for unsafe practices and conditions, and ensure prompt
corrective action to eliminate causes of incidents.

Employees

• Carry out their work in a manner that will not create a hazard to their own safety and
health or the safety and health of others.

• Assist site supervision in the reduction and controlling of incident producing conditions
and unsafe acts on the work site.

• Report any incidents, accidents, near misses and/or injuries immediate to their
supervisor.

• Report any anticipated loss of work time to his/her supervisor as soon as possible after
being treated by a physical following injury.

Site Administrator

• Responsible for daily administration of safety program on site.

• Post all safety bulletins, safety posters and safety rules and regulations.

• Assist project Superintendent(s) in incident investigations, analysis and preparation of

incident reports and summaries.

• Ensure that pertinent safety reports are submitted as required.

• Prepare descriptions of identified unsafe conditions and the steps taken to correct these
conditions.

• Maintain a list of safety equipment purchased.

• Prepare a copy of inspection reports on equipment.

• Prepare a copy of field safety inspection checklists.

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 • Ensure that correction action has been taken whenever deficiencies are identified.

• Assist with safety seminars or training.

• Maintain current knowledge of safety literature, regulations and codes of practice.

• Establish schedules of inspection

• Review the incident reports to keep informed about the project and company safety
performance.

Note: On projects where a Safety Administrator has not been assigned, the duties described
above become part of the Superintendent’s duties.

First Aid Personnel

For all jobs, the Superintendent will appoint adequate person(s) to provide such first aid
services as may be required given the nature of the job-site and government regulations. The
person(s) appointed to this position shall possess an appropriate certificate in First Aid in
accordance with the relevant regulations and must be available at all times to administer first
aid.

• Administer first aid as requested.

• Maintain a first aid log.
• Requisition all first aid supplies and equipment
• Maintain relationships with physicians, W.C.B., ambulance services and hospital.
• Assist Safety Officer when necessary.
• Provide health education materials or instruction to all on-site employees as required.

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 SAMPLE ASSIGNMENT OF RESPONSIBILITY

Managers

• To provide information, instructions, and assistance to all supervisory staff in order to

protect the health and safety of all our employees.

• To understand and enforce our incident prevention policy as well as the Occupational
Health and Safety Act.

• To provide all supervisory staff with an understanding of our incident prevention

program as well as relevant sections of the Occupational Health and Safety Act.

• To provide all supervisory staff with proper, well maintained tools and equipment, plus
any other special personal protective devices which may be required.

• To provide on going safety education programs and approved first aid training as
required.

• To monitor departments and projects and hold them accountable for their individual
safety performance.

Supervisors

• To know and apply the firm’s safety policy and relevant sections of the Occupational
Health and Safety Act.

• To ensure that all employees are educated to work in a safe manner and that they use
all protective devices and procedures required by this firm and by legislation to protect
their health and safety.

• To advise all employees of any potential or actual dangers and how to isolate, prevent
or remove them.

• To arrange for medical treatment as required in case of injury or illness, including

transportation to a doctor or hospital as necessary.

• To report all incidents immediately, to investigate all incidents fully, and to advise
management on how to prevent similar incidents in the future.

• To carry out regular inspections of the workplace to ensure a safe and healthy
environment.

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Employees

• To read, understand, and comply with this firm’s safety policy, safe work practices,
procedures, and rules.

• To wear the safety equipment and personal devices and clothing required by
regulations, manufacturers’ specifications and his/her employer.

• To notify his/her supervisor of any unsafe conditions or acts that may be of danger to
other workers or himself/herself.

• To report all incidents and injuries to his/her supervisor as soon as possible.

• To take every reasonable precaution to protect the safety of other workers and
himself/herself.

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 SAMPLE ASSIGNMENT OF RESPONSIBILITIES
Manager
• Establish a safety policy
• Provide a safe work place
• Maintain a safety program
• Ensure the proper training of
workers
• Ensure PPE is available
• Ensure regular inspections are
completed.
Supervisor/Foreman
• Promote safety awareness
• Establish safe work practices
• Instruct workers
• Correct unsafe practices
• Detect troubled employees
• Correct unsafe conditions.
Worker
• Use safe work practices
• Identify unsafe conditions
• Correct unsafe conditions
• Report unsafe acts
• Correct unsafe conditions
• Ensure first aid is provided
• Investigate incidents
• Report injuries to WCB
• Ensure compliance with regulations.
• Set a good example
• Enforce safety rules
• Inspect for hazards
• Investigate all incidents
• Ensure proper maintenance
• Comply with regulations
• Set a good example
• Report injuries
• Comply with rules and regulations
• Make safety suggestions
• Set a good example
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